Do Doctors Have the Right to Prescribe Based on Their Personal Morals

To me, this is a very interesting case. There is a doctor in my city who is refusing to prescribe birth control to patients based on her personal beliefs. This is unheard of, which is why it is making headlines. If you want to know the details, I suggest reading the link.

But what interests me most is people’s responses to the article. Most people are of the opinion that this doctor is there to help people. Her job is to prescribe medicine to those who need it. It is not her job to push her moral values on other people, and, if that is what she is going to do, she should not be a doctor. I agree with these people. If prescribing certain medications goes against your religious beliefs, then you should not be a doctor.

But this is not the response that you would get everywhere. While most Canadians that I know would say that if you have moral obligations that prevent you from doing your job you should find another job, I’ve spoken to many Americans who are of the opposite opinion. That’s not to say all Americans believe one thing and all Canadians believe another, but it is a trend that I have noticed when interacting with different people. Many Americans that I have spoken to would say that she has the freedom to believe what she wants and she cannot be forced to do something that goes against her religion.

Personally, I think this is a result of how both countries view religious freedom. The United States makes a lot of noise about the separation of church and state. It’s in the constitution. There’s a lot of court cases revolving around the separation of church and state. But in Canada, we have no such separation. In fact, the Anglican church is the established church of Canada. But we have a culture of religious belief is private. It tends to not be something we discuss openly and it is generally thought that religious beliefs belong at home and at church. There are certain problems with this, but it does generally mean that people won’t use their religion to avoid doing some aspect of their job. And we also don’t generally have to worry about religion being taught in public schools.

So, should this doctor be allowed to use her personal morals to avoid doing some aspect of her job, or should she have to find another line of work?

personal beliefs have no place in the treatment or diagnosing of any patient, when they deny without good medical reasons treatments or drugs which are legal and which the patient qualifies for and for whom it would benefit.

if you want to preach morality, go to the church and be a preacher. if you want to practice medicine, leave morals out of it.

I wouldn’t say leave morals out of it, but I would say leave personal beliefs out of it. There are people who’s job it is to determine what is moral and what isn’t. So long as the doctor stays within the limits that are already set, they will be fine.

Although I agree entirely with this post, that anyone in any job should perform the duties of their job regardless of their personal moral views and should not take a job that will make them go against their moral views, there is a massive issue with religion in the States.

I am a United States Citizen but am not American. I live in America currently and I can tell you part of the reason there is such an issue with religion in the States. There is a massive split between the religious and the anti-religious (as opposed to the non-religious). Americans tend to be ignorant on both sides of the issue. I wrote about this once before (http://sardonicmisanthropia.wordpress.com/2014/06/03/ignorance-and-america/).

Religion in America has become much more fundamental than in many other areas, particularly Christianity. There are even more things that, although likely having an ultimately religious basis in regards to Nietzsche’s views in “On the Genealogy of Morals”, are seemingly secular or have spread into the secular arena that are a hindrance to most people. Attempting to get a vasectomy or tubal ligation in America under the age of 35 is quite difficult when you’ve had no children. The only way to secure your right to such a procedure as a paying customer is to argue that you have legitimate medical reasons for this (like genetic predispositions to certain diseases and disorders).

This appears to be a bigger problem in the States than in the rest of the Western world, but I cannot say that with any absolute certainty.

However, there is a massive difference between the way the States and other nations view religion and law and morality. Part of this stems from the general American’s ignorance of their own country and its founding, as well as the varying philosophical movements that caused it to differ. When much of the UK was exploring Empiricism, America was exploring Transcendentalism. America, in a philosophical sense, is much like a petulant child that is vehemently opposing its parents out of illogical angst. This is not to say that there were no good ideas to come from American philosophical movements, but that there are many problems in America with regards to morality that are not seen in other Western nations and I honestly cannot pinpoint a logical reason even for its occurrence, let alone where and why it began.

Historically speaking, it seems to have come from the founding. The desire to escape persecution led to more persecution within the US. The wish to separate religion from politics led to religion being held up as more important than it was considered elsewhere. And, yes, the wish to be independent led to a rebellion against anything “English.”
It’s easy enough to see by looking at the history of the US, but it is still confusing. The level of extremes that they went to…it’s quite scary actually. Looking at it from the outside, I’d be terrified to move to the US.

But yes, America is not, relatively, that scary of a place. More scary than Americans or the USA is the general American way of thinking. It promotes extreme bias and polar division based on emotional thinking rather than logical or rational thinking.

In the States, political-type rhetoric permeates all forums of speech, even in private between two individuals. Another notable difference is that Americans have a tendency to butt-in with “advice” or opinions that were never asked for. Pollyanna delusions and malignant positivity/optimism bias are rampant as well. They view the pointing out of bad situations not as realism, but as pessimism. Generally, anything not sugar-coated and overly saccharin is considered negative and bad and will not be listened to.

They generally respond very poorly. Americans, in general, tend to have a very high opinion of themselves and their country as Americans.

I was actually just coming back to make a comment along those lines.

They take a lot of pride in things that are meaningless and they will go above and beyond to “prove” they are forward-thinking. For example, when President Obama was elected, you heard a lot from “the Left” about how “progressive” America was for electing a black man as President. Well no, that’s not progressive, because you’re still focusing on race. Voting for him just because he is black is equally as racist and anti-progressive as not voting for him because he’s black. A lot had been focused on in his initial campaign about race and gender.

Yet you look at Chancellor Angela Merkel in Germany and generally, nobody cared that she was a woman, only whether or not she could do the job. Nobody felt “progressive” for her appointment to Chancellor. I mean not only is she the first female Chancellor in Germany, she’s also the first to come from a science background, the first to come from West-Germany post-reunification, etc etc etc.. She wasn’t chosen for these reasons, she was chosen because she proved she was best for the job.

A lot of things are emotionally charged and anything you say that puts America in a bad light or points out a true negative about America will generally be met, by Americans, with claims of you being anti-American.

Another issue in the States, that I cannot say is any bigger of a problem than other nations (but would not doubt that it is), is the political sophistry with everything that happens. When the story of Elliot Rodger in California broke, nobody wanted to put the blame on Rodger since he was dead, they all wanted to blame the police and his psychiatrists and his parents. There was another story of two 12 year old girls stabbing their classmate and claiming it was the fault of the Slenderman stories on CreepyPasta and everyone wanted to blame the parents. Americans are really bad about viewing those who are under the age of 18-21 as being totally innocent and incapable of anything. Actually, they have a very hard time accepting reality when something small causes something great and conspiracy theories run rampant in America. They also don’t like to think a person could be perfectly normal and still do something heinous. They assume anyone doing something wrong must be mentally ill or something.

In the courts, “liberty” is given a higher position than justice. I could go on and on with examples but it would stray further from the point.

In general, Americans would view this article and be extremely split: there would be a very strong pull that the doctor should be allowed to reject giving medication to someone because of their own beliefs and a strong pull that the doctor should not be allowed to reject giving medication to someone because of their own beliefs.

Not many would take the position that somebody should not perform a job that may force them to have to do things which are against their moral beliefs. While you could argue that the person should just go to another doctor, that is not always an option in America as not all insurance companies are not universally accepted everywhere. Some will argue that the law doesn’t forbid the doctor from doing what he did and some will argue that it does forbid it.

When it all comes down to it, if you work in a secular field, your personal religious or moral bias cannot factor into what you do when it affects other people and limits their rights for things. For example, I never want children. I KNOW this for a fact. Given that I am 27 years old, I will still be hard pressed to get a doctor to perform a vasectomy on me due to their personal natalist beliefs. There’s no law that says that they HAVE to perform such a procedure on a person who is paying for it (even in full, out of pocket).

The problem often is that people want to allow everyone to be happy, and that cannot happen if you don’t concede to things. For example, the gay marriage debate in America. There is no logical opposition to allowing homosexuals to marry: marriage is a secular contract between two people. The idea of a “Christian marriage” didn’t even exist until the 1600s. Yet Americans will vehemently oppose it because the law says “man and a woman”, despite historical relevancy dictating that what was meant was that marriage is between two human beings, not a human being and an animal or property (I.E. slaves). Some people act as though, if it were legalised, that religious institutions would be forced to perform gay marriages. Now that shouldn’t be the case. If it were legal, it would affect NOBODY except the homosexuals. However, the English language has always been one that was very political which made sophistry and rhetoric easier, but America has taken that to an extreme. It is very easy to say something indirectly without actually saying it and, despite everyone knowing exactly what was meant, nothing can be done because it’s not explicit (liberty over justice).

Another example of something that you see discussed world-wide is right-to-die issues and physician-assisted suicide. This is a subject very taboo in America. Another thing you’ll notice is that Europe, in general, is much more sexually open than is America (which is currently stuck in a level of sexual-repression comparable to the Victorian Era of England).

It’s perfectly normal to see unnatural levels of gore and violence in American programming and not many think twice about it, but if a breast is shown in a clearly non-sexual context, they will still get up-in-arms over it.

I have to back out of this discussion now, because I have too much to say on it in a bunch of comments.

In Canada, we have a very interesting mix of an American and European style government. On one hand, right to die legislation is being discussed and is supported. We’ve had legal gay marriage for a decade, and we are more center-left of center in government style. But many of us worry that our current Prime Minister, who idealizes the American style of government, has taken us too far right and will cause lasting damage.
I know a woman who wasn’t allowed to have a historicity until she was 30 “just in case she wanted children” despite having a medical condition that would have been alleviated by having them removed and being an out lesbian who was adamant that she never wanted children. We also focused to much attention on the sex of the one female prime minister that we had (she didn’t last very long in office).
I have to say, nationalism annoys me. I find a lot of Canadians are too focused on nationalism. But nobody can out “nationalism” the Americans.

Another thing happened today in America that further solidifies this point. Hobby Lobby is a for-profit organisation that does not specifically cater to Christians or sell only Christian goods. They’ve claimed to be a religious organisation.

They refuse to cover, with their health care as mandated by law, 4 types of contraceptives they BELIEVE (despite empirical evidence to the contrary) to be abortifacients.

These have been proved beyond any doubt to not be abortifacients, yet the supreme court has placed “liberty” over justice once again and declared that this organisation, by all appearances and any accounts is not a religious institution but a secular business, has rights as a corporation to claim a religion (as corporations in America are treated as persons and have several rights individuals have) and that their belief, DESPITE EVIDENCE TO THE CONTRARY, that these contraceptions are abortifacients is sufficiently demanding of their religion and that they don’t have to cover them. This is also that much more ridiculous when you consider the fact that the organisation itself would have no idea for what the insurance is being used and therefore cannot be burdened by something they don’t even know exists.

If the doctor’s personal belief is that birth-control will cause harm to her patients, then her reluctance to prescribe becomes more understandable. Do any of the reports explain why she refuses to prescribe it?

There is a doctor in my local practice who will not prescribe birth control, refer for abortions or refer for sterilisations. There’s a sign on the reception desk that explicity states this.

Some suggest religious motivations, but the doctor herself has not said. But she avoids writing prescriptions for any birth control, which is problematic. She’s not really doing a whole lot of harm to the majority of women who use birth control for reproductive purposes. It’s easy enough to get else where. But what about the women who use it for medical reasons? She could be harming them by not writing prescriptions. She’s going against her Hippocratic oath for that fact alone.
Her willingness to do any undue harm for personal reasons is the biggest reason why people say she should find a different career path. If it’s your job to help people, then you should help them by doing what’s best for them (using their knowledge of themselves as well as your own knowledge) and not simply press your own morals on them. Regardless of her own beliefs, it is best for a lot of patients to have the birth control that they’re asking for.

And that’s the point I’m making. What if her belief is that it isn’t best – that there is a more appropriate way to treat these patients? Not having heard from the doctor herself, any opinions regarding her reasons are speculative at best. It may be a religious belief, but it might also be an ethical stance.

What does her personal belief have to do with her job? There is an ethics board to make sure that the doctors have certain standards. According to that ethics board, birth control is perfectly acceptable. If she can’t do her job, then why can’t she find another one?

A surgeon may refuse to perform surgery if they feel that the risks outweigh the benefits. Why should a general practitioner not be extended the same autonomy?

Again, without knowing her reasons, this is all speculation. But I would maintain that if a doctor has sound reason to believe that the harm of a treatment outweighs the benefits (and I include harm to the unborn child here), then they should have the option to refuse to provide that treatment.

A surgeon needs to have a good reason to refuse to perform a surgery. They have to justify it. They can’t just say “it my opinion it’s unsafe.” Doctors in general should have the same responsibility. She says birth control is harmful? Okay, let her justify her opinion in front of a board of her peers. If they agree, fine. If they disagree and she still refuses, then she loses her license.
What unborn baby? We’re talking about the pill. Women take it to prevent the egg from being fertilized. Even if you believe that life starts at conception, there is no conception.

Saying that she should lose her licence is a big call. Normally, taking away someone’s medical licence only occurs in a cases of gross misconduct or malpractice.
Our code of conduct and code of ethics in Australia would deem her practice acceptable, so I’d be surprised if Canada differed so greatly that her licence could be suspended.

The main mechanism of action of the contraception pill is to prevent ovulation, and therefore conception. One of the secondary mechanisms of action, particularly of the progestin-only pills, is to thin the lining of the uterus, making it unsuitable for implantation. Therefore if conception did occur – and we all know that contraception failures happen – then the embryo would be unable to implant and would flushed from the woman’s body.

We don’t know if she believes that birth control is harmful, and I don’t like to ascribe opinions to her that may or may not be accurate.

As a pharmacist in the U.S., in all the states I’ve practiced we may refuse to fill any prescription without explanation. It is actually in the laws that regulate the profession in many states. The only exception I can think of is if you are a pharmacist working in the military.

Here the broader view would be that the person has the freedom to choose another physician who will comply with her wishes. As long as the physician is acting legally and ethically (does no harm), they are free to practice medicine as they choose to.

Many physicians now refuse to prescribe pain meds with no repercussions. They just don’t want to have to deal with the DEA and potential addicts. They make it clear to their patients that is not something they will prescribe and these physicians are free to do so. At least that is how it is here in Georgia.

I know several people who choose their physician based on his or her religious beliefs. I know of physicians praying with people for healing as part of their practice.

Those who may not believe in God may be put off by this and decide to put their confidence in another physician. The choice is theirs.

I’ve never heard of a physician praying with a patient here. It’s also not really likely that a patient will know their physician’s religion. If they asked, they’d likely be told it was none of their business. Though I don’t think many people would feel it appropriate to ask. We don’t even generally know our politicians’ religious beliefs.

Yes: doctors do what is “right”, and unfortunately, that is never clear in any particular segment of the world, much less medicine.

For example, if a doctor knows that a certain pain medication has a high chance of forming an unhealthy addiction with the patient, they may choose not to prescribe it even if the patient’s pain and suffering may dictate it. That is a moral decision. A moral decision is any one that is made where judgment comes into play, and doctors must be judges constantly.

In the case of birth control, it is more obvious that the decision is moral, but it would be impossible to divorce morality from any doctor’s choices.

But bias is why we have certain standards. For example, if a doctor chose to withhold a drug from a patient for fear that the patient would become addicted, but, by withholding that medication, the doctor caused the patient undue harm (ie. they were under too much pain to function normally), that doctor could be charged and lose their license.